-Airway change request-

[MacBook]

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I've been lurking on here and posting the random little thing here and there and now have a question on a more personal matter.

I did search and tried to find the "Stupid Question" section for people who know nothing about anesthesia but they haven't started one yet, please bear with me.

a simple answer will suffice.

Let's say that one has just been booked for surgery, would it be legit to make a request to use a different airway than what is typically used?

Background: Have had multiple ops in the past where waking up in recovery has been a little on the slow side. Never any problems just unable to wake up enough to convince the nursing staff to remove the LMAs upon waking up. Obviously for my own safety.

Being slow to "come to" in recovery I have found LMAs to be quite painful.

Would it be a legit request to be made? or should I be quiet, finish my soup and not make a fool of myself😳

 

[psychbender]

Just don't phrase it like "I WANT X!!" Instead, let your anesthesiologist know about your history and concerns the first time you meet.

 

[Bougie]

Depending on the surgery you are having, ask your anesthesiologist about a regional technique (epidural, spinal, nerve block). This can be done in addition to a little light sedation (no airway device) so you have a clearer head postop and bypass the sore throat. Having had knee work done myself, trust me, this is the best way to have procedures done if it is an option.

 

[coprolalia]

An ETT is less painful than an LMA? 😱

-copro

 

[Planktonmd]

Interesting!
So every time you had surgery you woke up in the recovery room with an LMA still in place and the recovery room nurses were responsible for extubating you?
If I were you I would go have surgery somewhere else.

 

[MacBook]

Interesting!
So every time you had surgery you woke up in the recovery room with an LMA still in place and the recovery room nurses were responsible for extubating you?
If I were you I would go have surgery somewhere else.

It's actually quite common for patients to be discharged in recovery with airways still in place, thing is most don't ever recall ever waking up with one still in place as they are usually removed shortly after they arrive in recovery.
I guess some of us are just a little show on the uptake.

 

[Planktonmd]

It's actually quite common for patients to be discharged in recovery with airways still in place, thing is most don't ever recall ever waking up with one still in place as they are usually removed shortly after they arrive in recovery.
I guess some of us are just a little show on the uptake.

I think you are confusing oral airways with LMA's.
It's not common to send patients to the recovery room with an LMA in place but this is done in places with fast turnover where they don't want to wait for the patient to wake up before they go to recovery.
Oral airways are frequently left in place on the way to the recovery room but they are not that annoying and the patient usually spits them out when they are awake enough.
If you are waking up every time with an LMA still in place in the recovery room then again I advise you to find another place to have surgery.

 

[MacBook]

I think you are confusing oral airways with LMA's.
It's not common to send patients to the recovery room with an LMA in place but this is done in places with fast turnover where they don't want to wait for the patient to wake up before they go to recovery.
Oral airways are frequently left in place on the way to the recovery room but they are not that annoying and the patient usually spits them out when they are awake enough.
If you are waking up every time with an LMA still in place in the recovery room then again I advise you to find another place to have surgery.

I do not know as to what the protocols are here. I work pre-hospital not "in" so I'm not sure. Most of these ops have been done at our main trauma centre so what you describe with turn around time sounds appropriate for this situation.

 

[VentdependenT]

WHats the operation?

Conceptually, in my mind there is no difference between an oral airway and an LMA (difficult airway algorithm aside). Both are big hunks of plastic sitting in the back of the throat. Both can cause larnygospasm if the patient is stage II. Both are supraglottic devices.

I've dropped a couple of patients off in the PACU with the LMA in but I pulled em at the end of signout.

 

[MacBook]

A burmingham hip resurfacing.

 

[Intubate]

I think you are confusing oral airways with LMA's.
It's not common to send patients to the recovery room with an LMA in place but this is done in places with fast turnover where they don't want to wait for the patient to wake up before they go to recovery.
Oral airways are frequently left in place on the way to the recovery room but they are not that annoying and the patient usually spits them out when they are awake enough.
If you are waking up every time with an LMA still in place in the recovery room then again I advise you to find another place to have surgery.

What's wrong with leaving them with an LMA? Its no different than leaving them with an oral airway. The patient can take out their LMA as easily as they can their oral airway. Its a style issue. I don't do it because the nurses make weird faces when they see the LMA sticking out. I think its fine though.

 

[MacBook]

It's actually been standard practice here to leave the LMAs in which is why I asked in the first place. I really appreciate the time taken to post up your thoughts.

 

[Planktonmd]

WHats the operation?

Conceptually, in my mind there is no difference between an oral airway and an LMA (difficult airway algorithm aside). Both are big hunks of plastic sitting in the back of the throat. Both can cause larnygospasm if the patient is stage II. Both are supraglottic devices.

I've dropped a couple of patients off in the PACU with the LMA in but I pulled em at the end of signout.

What's wrong with leaving them with an LMA? Its no different than leaving them with an oral airway. The patient can take out their LMA as easily as they can their oral airway. Its a style issue. I don't do it because the nurses make weird faces when they see the LMA sticking out. I think its fine though.

I disagree with the idea that an LMA is as well tolerated as an oral airway.
They are both supraglottic but patients tolerate oral airways much better than they tolerate LMA's and they can simply spit out an oral airway while an LMA gives them a sense of suffocating.

 

[MacBook]

I disagree with the idea that an LMA is as well tolerated as an oral airway.
They are both supraglottic but patients tolerate oral airways much better than they tolerate LMA's and they can simply spit out an oral airway while an LMA gives them a sense of suffocating.

agreed on that point.

 

[Jeff05]

just tell them you don't want to wake up in the recovery room with an LMA if possible. tell them, very nicely, that you had a BAD EXPERIENCE in the past. that's it.

i don't care how fast the surgery is - pulling an LMA deep and sticking in an oral airway, or just turning the head to the side isn't hard to do and is usually enough.

 

[MacBook]

just tell them you don't want to wake up in the recovery room with an LMA if possible. tell them, very nicely, that you had a BAD EXPERIENCE in the past. that's it.

i don't care how fast the surgery is - pulling an LMA deep and sticking in an oral airway, or just turning the head to the side isn't hard to do and is usually enough.

I tend to be blunt, just never want to overstep my boundaries. He is the anesthetist and the health professional who will be in charge in caring for me. Don't want to piss'em off😀

I appreciate that opinion. Might have to wait and see what he's like and see which thing is most appropriate to say to get the point across without sounding like I'm interfering with his routine.

 

[jetproppilot]

If you are waking up every time with an LMA still in place in the recovery room then again I advise you to find another place to have surgery.

Agreed, but only if you are referring to the United States.

In the UK almost everyone who gets an LMA (which is alot since it is more widely used there than here) goes to PACU with it in place.

 

[Planktonmd]

Agreed, but only if you are referring to the United States.

In the UK almost everyone who gets an LMA (which is alot since it is more widely used there than here) goes to PACU with it in place.

True, But that means keeping the patient deeply anesthetized until the very end and taking the patient to recovery where he/she will be handed to an experienced recovery room nurse who knows how to recognize the correct time to remove the LMA without torturing the patient unnecessarily, how many recovery room nurses in the U.S. can do that in your opinion?
I am not saying they are less competent but they simply don't have the experience.

 

[Intubate]

True, But that means keeping the patient deeply anesthetized until the very end and taking the patient to recovery where he/she will be handed to an experienced recovery room nurse who knows how to recognize the correct time to remove the LMA without torturing the patient unnecessarily, how many recovery room nurses in the U.S. can do that in your opinion?
I am not saying they are less competent but they simply don't have the experience.

I guess I'm arguing just for the sake of arguing (cause as I said, my lma's come out in the OR), but this doesn't make sense. Is it unnecessary torture to take an LMA (or ETT) out of an awake patient in the OR? If not, how is that different from taking it out in the PACU (with regard to patient comfort)? When they wake up, take it out. This idea doesn't take a lot or training or experience to understand. The more important concept is to not take it out too early-- that could be a worse problem than discomfort.

 

[Planktonmd]

I guess I'm arguing just for the sake of arguing (cause as I said, my lma's come out in the OR), but this doesn't make sense. Is it unnecessary torture to take an LMA (or ETT) out of an awake patient in the OR? If not, how is that different from taking it out in the PACU (with regard to patient comfort)? When they wake up, take it out. This idea doesn't take a lot or training or experience to understand. The more important concept is to not take it out too early-- that could be a worse problem than discomfort.

For the sake of argument as well, I think before you start taking patients with LMA to PACU regularly you need to make shure that your PACU nurses are trained to be able to recognize the right time to take the LMA out and balancing safety with patient comfort.
If they are not experienced I can see them keeping the LMA too long for fear of loosing the airway and that would be unfair to patients.